Abdominal pain, no passage of wind and vomiting. Bowel obstruction?
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A large stone of around 2 cm is sitting in the ileum with markedly distended proximal fluid-filled small bowel. Note a fistula (inflammatory mass) between the thick-walled gallbladder and duodenum with gas in the gallbladder lumen. All are features typical of gallstone ileus.
Gallstone ileus occurs when a large gallbladder stone erodes into the duodenum via a fistula, eventually obstructing the ileal lumen usually some centimetres proximal to the ileocaecal junction.